Provider Demographics
NPI:1558609735
Name:LAKESHORE DENTAL
Entity Type:Organization
Organization Name:LAKESHORE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARNETT
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-206-0977
Mailing Address - Street 1:210 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3031
Mailing Address - Country:US
Mailing Address - Phone:501-206-0977
Mailing Address - Fax:501-206-0922
Practice Address - Street 1:210 N 2ND ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3031
Practice Address - Country:US
Practice Address - Phone:501-206-0977
Practice Address - Fax:501-206-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty